Trust your gut? Evaluating non-expert gastric ultrasound performance – A prospective observational cohort study

IF 5.1 2区医学 Q1 ANESTHESIOLOGY

Journal of Clinical Anesthesia Pub Date : 2026-01-01 Epub Date: 2025-11-10 DOI:10.1016/j.jclinane.2025.112053

Sarah Baumann , Firmin Kamber MD , Thierry Girard MD , Eckhard Mauermann MD, PhD, M.Sc , Reza Kaviani MD

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引用次数: 0

Abstract

Background

Aspiration of gastric content is a serious complication of anesthesia, associated with high mortality and morbidity. Recent studies demonstrated that fasting status can be assessed accurately by gastric ultrasound. However, there is still a lack of evidence regarding the application of this technique by inexperienced examiners. We aimed to determine the accuracy of gastric ultrasound performed by medical students after a standardized training sequence.

Outcome

Accuracy of identifying the fasting status by gastric ultrasound performed by inexperienced examiners.

Methods

In this prospective observational cohort study, five medical students performed 80 gastric ultrasound examinations on healthy, non-obese volunteers. Standardized training consisted of blended online training, one plenary lecture, and 2 h of hands-on-training. Volunteers were randomized in a 2:1:1 ratio to "fasted", "non-fasted, fluid", and "non-fasted, solid" with the examiners being blinded to the fasting status. The examiners determined the fasting status using gastric ultrasound and recorded the gastric cross-sectional area. Beforehand, an expert examiner also conducted all examinations for comparison. Sensitivity, specificity, positive and negative predictive values were calculated from the acquired data. The cross-sectional area was pooled for the expert and non-experts and the results plotted and interrater reliability assessed by the intraclass correlation coefficient (ICC).

Results

Data from 80 individuals were analyzed. The inexperienced examiners correctly identified all non-fasted volunteers (sensitivity 1.00,95 % CI: 0.91–1.00). They wrongly classified 18 out of 40 fasted volunteers as "non-fasted" (specificity 0.55, 95 % CI: 0.40–0.69). Positive predictive value was 0.69 (95 % CI: 0.56–0.79) and negative predictive value 1.00 (95 % CI: 0.85–1.00). The overall ICC was 0.72 (95 % CI 0.57–0.82), and 0.30 (95 % CI -0.32–0.63), 0.66 (95 % CI -0.16–0.87), and 0.27 (95 % CI -0.82–0.71), for the "fasted", "non-fasted, fluid", and "non-fasted, solid" states, respectively.

Conclusions

Examiners with limited experience in ultrasound diagnostics may accurately identify a full stomach in normal-weight volunteers after a standardized training sequence. However, the detected specificity of 0.63 was low, and more focused training on the ultrasound anatomy of an empty stomach may be needed to rule out an empty stomach in a clinical scenario.

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相信自己的直觉？评估非专家胃超声表现-一项前瞻性观察队列研究。

背景：胃内容物误吸是麻醉的严重并发症，死亡率和发病率高。最近的研究表明，胃超声可以准确地评估空腹状态。然而，关于没有经验的审查员应用该技术的证据仍然缺乏。我们的目的是确定医学生在标准化训练后进行胃超声检查的准确性。结果：没有经验的检查人员通过胃超声检查确定禁食状态的准确性。方法：在这项前瞻性观察队列研究中，五名医学生对健康的非肥胖志愿者进行了80次胃超声检查。标准化培训包括混合在线培训、一次全体讲座和2小时的实践培训。志愿者按2:1:1的比例随机分为“禁食”、“非禁食、流质”和“非禁食、固体”，审查员对禁食状态不知情。检查人员使用胃超声确定空腹状态并记录胃横截面积。在此之前，一名专家审查员也进行了所有的检查以进行比较。根据获得的数据计算敏感性、特异性、阳性预测值和阴性预测值。将专家和非专家的横截面积汇总，绘制结果，并通过类内相关系数（ICC）评估组间信度。结果：分析了80例个体的数据。没有经验的检查人员正确地识别出所有未禁食的志愿者（灵敏度1.00,95% CI: 0.91-1.00）。他们错误地将40名禁食志愿者中的18人归类为“非禁食”（特异性0.55,95% CI: 0.40-0.69）。阳性预测值为0.69 (95% CI: 0.56 ~ 0.79)，阴性预测值为1.00 （95% CI: 0.85 ~ 1.00）。对于“禁食”、“非禁食、流质”和“非禁食、固体”状态，总体ICC分别为0.72 （95% CI 0.57-0.82）、0.30 （95% CI -0.32-0.63）、0.66 （95% CI -0.16-0.87）和0.27 （95% CI -0.82-0.71）。结论：超声诊断经验有限的检查人员可以在标准化的训练序列后准确地识别正常体重志愿者的饱胃。然而，0.63的检测特异性较低，可能需要对空腹超声解剖进行更集中的培训，以排除临床场景中的空腹。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Clinical Anesthesia 医学-麻醉学

CiteScore

7.40

自引率

4.50%

发文量

346

审稿时长

23 days

期刊介绍： The Journal of Clinical Anesthesia (JCA) addresses all aspects of anesthesia practice, including anesthetic administration, pharmacokinetics, preoperative and postoperative considerations, coexisting disease and other complicating factors, cost issues, and similar concerns anesthesiologists contend with daily. Exceptionally high standards of presentation and accuracy are maintained. The core of the journal is original contributions on subjects relevant to clinical practice, and rigorously peer-reviewed. Highly respected international experts have joined together to form the Editorial Board, sharing their years of experience and clinical expertise. Specialized section editors cover the various subspecialties within the field. To keep your practical clinical skills current, the journal bridges the gap between the laboratory and the clinical practice of anesthesiology and critical care to clarify how new insights can improve daily practice.